Hesperian Health Guides
Medicines for AIDS – Antiretroviral Therapy (ART)
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(see also information about ART in the chapter on HIV and AIDS)
Certain medicines can help people with HIV live longer and healthier lives. Taken daily as a combination of at least 3 medicines, this is called Antiretroviral Therapy, or ART.
HIV care and ART programs
HIV is a complicated disease that affects every part of your body. As soon as you
have a positive HIV test, try to find an HIV care program that can provide medicines to
prevent and treat HIV illnesses, counseling and other support. They can help you start
ART and manage any possible side effects. Getting drugs from an ART program is more
reliable and less costly than buying them from a private source.
When is ART needed?
People who test positive for HIV and show signs that their immune system is becoming weak need ART. A blood test called a CD4 cell count can measure how well the immune system is working. If your CD4 count is below 350, even if you feel healthy, you should talk to your health worker about starting ART.
If you are pregnant and test positive for HIV, you should start ART even if you do not get a CD4 test.
Before starting ART, it is important to discuss with your health worker:
- Have you ever taken any ART before? This may affect what medicines you should take now.
- Do you have any illnesses or serious infections such as pneumonia? They may need to be treated first.
- Do you know about the benefits, risks, and possible side effects of ART? Try to talk to someone who is already using ART as well as your health worker.
- Are you able to take medicines every day, at the correct times? This is necessary for ART to work.
- Is a steady supply of the medicines you need available?
- Have you told at least one person that you have HIV? She or he may be able to help if something prevents you from getting or taking your medicines.
- Is there an HIV support group you can turn to for information and help?
Do not start taking ART on your own. They may be the wrong medicines for you and can have serious side effects or cause drug resistance.
Do not share ART medicines with anyone. The medicines will not work if you take less than the recommended dose.
Do not buy ART from someone who is not part of an approved HIV care or ART program.
How to take ART
ART is effective only in combinations (regimens) of at least 3 medicines. Some medicines are combined into 1 or 2 tablets or capsules so there are fewer pills to take. This makes taking medicines every day easier. The 3 combinations described lower on this page are widely available, have fewer side effects, and are safer. Depending on what is available, other combinations of medicines may be used where you live.
- Whatever combination you use, take each medicine every day, at the same time of day.
- Twice-a-day medicines should be taken every 12 hours. For example, if you take the first dose at 6:00 in the morning, then the second dose should be taken at 6:00 in the evening. Some medicines need to be taken only once a day (see 'When to take medicines').
Side effects of ART
ART can have side effects. Some side effects decrease and go away completely with time. Others appear only after you have taken a medicine for a long time. Some common side effects are bothersome but are not serious, such as diarrhea, tiredness, headaches, and stomach problems. Talk to your health worker about how to handle these problems. But keep taking all your medicines until your health worker tells you to change or stop.
Other side effects can be life-threatening, such as severe liver problems, severe tiredness with shortness of breath, skin allergies and rashes, tingling or burning in the hands and feet, and anemia. If you have serious side effects, see a health worker right away.
Drug resistance – first and second line combinations
The ART you start on is called a first line combination, or first line regimen. Over a period of years, HIV can become resistant to ART. Many people may need to switch to a second line of drugs. Talk to your health worker about which drugs work in your area and if you need to change.
These recommendations for ART are based on the newest information we have as of April 2019. Changes in drugs: Any of the combinations below may be available as one pill, taken once daily.
- Combinations with dolutegravir (DTG) are recommended for all women without hepatitis or liver problems, but it is not clear if DTG might cause birth defects, so women of childbearing age may wish to avoid it.
- Combinations with efavirenz (EFV) are now recommended for all women, including women who are pregnant or breastfeeding.
- Emtricitabine (FTC) can substitute for lamivudine (3TC) in combinations that also include tenofovir (TDF) or dolutegravir (DTG). The dose for FTC and 3TC in those combinations is the same.
Changes in when to start: People with HIV should start ART early while they are still healthy to avoid serious illnesses. HIV positive people should start treatment, even if no CD4 test is available.
Changes in who to treat: All pregnant, HIV positive women should start treatment. ART should also be started for anyone with HIV and active TB or hepatitis B infection, no matter what their CD4 count is, or whether they have advanced HIV disease.
ART Combinations for adults and adolescents (not for children under 10 years old)
||300 mg once a day||Can cause kidney problems||
||150 mg 2 times a day,|
||300 mg once a day|
||50 mg once a day.||Take 50 mg 2 times a day if also taking rifamicin for TB||
||400 or 600 mg once a day||Better choice if planning to get pregnant (not for people using hormonal contraception)||
|Medicines||Dose||Warnings and side effects||Advantages|
||250 to 300 mg|
2 times a day
Low white blood count
||150 mg 2 times a day, or|
300 mg once a day
||600 mg once a day||Not for people using hormonal contraception|
|Medicines||Dose||Warnings and side effects||Advantages|
||300 mg once a day||Can cause kidney problems|
||150 mg 2 times a day,|
|emtricitabine (FTC)||300 mg once a day|
|Atazandvir + ritonavir (ATV/r)||300 mg + 100 mg once daily||Not for people with hepatiits B, liver disease, or sulfa allergy|
|Darunavir + ritonavir (DRV/r)||800 mg + 400 mg daily|
|Lepinovir + retonavir (LPV/r)||600 mg + 100 mg 2 times a day||Not for people using hormonal contraception|
ART for pregnant women
All pregnant women who have HIV should start ART to maintain or improve their health. ART will also help prevent HIV from spreading to the baby. Once a pregnant woman starts an ART combination, she should continue for the rest of her life.
A woman who is already on ART when she becomes pregnant should continue taking it throughout her pregnancy, during the birth, while breastfeeding, and after. When her baby is born, he will also need medicines.
Preventing Mother-to-Child Transmission, or PMTCT
To prevent HIV spreading to her baby, a pregnant woman with HIV needs to take ART medicines during pregnancy, labor, and breastfeeding. The baby will also need medicines. Medicines are only one part of preventing HIV in a baby. Safer sex during pregnancy, safe birth practices, careful feeding of the baby, and treatment of illnesses in both mother and child are also important to prevent babies from getting HIV.
|ART medicines to prevent HIV in babies (mother-to-child transmission)
If the mother IS already taking ART, she should continue taking her medicines and also give the baby the medicines listed in Option 1.
If the mother IS NOT taking ART, she and her baby should take the medicines listed in Option 1 or in Option 2. Use medicines recommended and available in your country.
FOR THE MOTHER
|FOR THE BABY|
|Start taking one of the combinations of ART as soon as possible. You will need to take ART medicines every day for the rest of your life.||Whether or not the baby is breastfeeding, the baby should be given:
FOR THE MOTHER
FOR THE BABY
|During pregnancy, starting as soon as possible from 14 weeks of becoming pregnant she should take:
During labor, she should take: • NVP (nevirapine), 200 mg, in a single dose when labor starts, AND
After the birth, she should continue taking for 7 days:
|Immediately after birth, the baby should be given:
If the mother IS TAKING ART, continue giving the baby this NVP dose every day for 6 weeks.
If the mother is NOT TAKING ART'and is 'NOT breastfeeding, continue giving the baby this NVP dose every day for 6 weeks.If the mother is NOT TAKING ART and IS breastfeeding, continue giving the baby this NVP dose every day until 1 week after she stops breastfeeding
Preventing HIV right after a woman has been exposed to it
When a woman is exposed to HIV, for example when a health worker is stuck with a needle or a woman is raped by someone who probably has HIV, it is sometimes possible to prevent getting HIV by taking ART medicines for a short time. This is called Post Exposure Prophylaxis, or PEP.
If you think you have been exposed to HIV (see How HIV is Spread), talk with a health worker you trust as soon as possible about whether starting PEP is the best decision for you. You should start taking PEP medicines within a few hours, and no later than 3 days after, exposure. Start one of the ART combinations, preferably Combination 1 or Combination 4. Other combinations may be available and recommended in your area. Whatever combination you use, take the medicines for 28 days.